Why Don't We Talk About Painful Sex?

Isn't this supposed to be enjoyable? Liana, 31, remembers thinking repeatedly when she started having sex. For years she didn't understand why it hurt so much—until she ended up at her doctor's office, seeking treatment for her debilitating periods, fatigue, and constant spotting. There she learned that she had endometriosis, a condition in which uterine tissue grows outside the uterus. After getting surgery and learning vaginal stretches, she has been able to have sex with her boyfriend without pain.

Painful sex is really common, but women don't often discuss it. But we should; it's normal, and not discussing it with our ob-gyns can delay treatment and results. (Especially when it might take your doctor a while to figure it out, anyway—Zosia Mamet recently spoke at a conference where she explained it took six years for doctors to properly diagnose her pelvic floor dysfunction, a major symptom of which was painful intercourse.)

Jen, 39, would always try to rush through sex to keep the pain minimal. She didn't think it was a big deal, and she didn't talk to anyone about it. Then an ob-gyn she was seeing for a different reason noticed tightness in her muscles and diagnosed her with pelvic floor muscle spasms. She and her husband have been able to adjust now that they know this: They limit the amount of time they spend on intercourse and focus more on foreplay to keep the discomfort at bay.

A British study published earlier this year in BJOG: An International Journal of Obstetrics and Gynaecology found that one in 10 women experiences pain during sex. There are many possible causes, according to sex researcher Nicole Prause, Ph.D. Sometimes it indicates a medical condition like endometriosis or vulvodynia, a chronic pelvic pain condition. But the most common issue that correlates with pain during sex is repeated yeast infections.

"A history of dealing with them seems to semipermanently make the skin in the vulva very sensitive and painful," says Prause. The most common place to experience pain is right at the back of the vaginal opening.

Treatments for sexual pain depend on the cause, but can include physical therapy focused on the pelvic floor, vaginal dilators that help you relax these muscles, and partnered touch under a therapist's guidance.

Tara Langdale-Schmidt, 32, uses a vaginal dilator right before sex to reduce the pain caused by her vulvodynia. "We tried numerous compounded creams and nothing worked," she remembers. "Magnetic vaginal dilators 20 minutes before intercourse relaxed my muscles and created the blood flow to that area, which helps with lubrication."

Another potential source of discomfort is vaginal dryness, which can arise from hormonal fluctuations or medications and be prevented by a healthy dose of lube, says Jordan Tishler, M.D.. And sometimes the problem's not with your vagina but with the kind of sex you're having. If it hurts when a penis or another object bangs against your cervix, try using less deep thrusting, incorporating more foreplay, or switching to a position like cowgirl or doggy style that provides shallower penetration.

Other times the cause is more psychological, says Tishler. Some women experience pain during sex because they're tense or not turned on, which could be the result of relationship issues or negative feelings associated with sex. If there's no apparent medical cause for the pain, seeing a therapist might be helpful. The issue can also be age-related: Some women find that they begin to experience painful sex with menopause.

Whatever the cause, the important thing to remember is that you don't have to suffer through pain during sex. There are plenty of remedies, so talk to your doctor. And in the meantime, there are lots of alternatives to penetration, so figure out what's fun and comfortable for both you and your partner.